Health Care Reform:

Health Insurance & Affordable Care Act

Getting Health Insurance: It's a Marathon

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In the end, even if consumers enroll and pay, they still could face delays in getting the all-important card. Insurance companies have up to 10 days to issue a card once they receive the payment.

If aspiring beneficiaries don’t manage to get on insurers’ rolls by the New Year, many people could show up at doctors' offices and hospitals in January believing they are insured when they're not.

Glenn Melnick, a health care finance professor at the University of Southern California, said the number of steps and agencies involved in the sign-ups is a problem. "When a single entity doesn't control all of the details of an enrollment process, there is lots of room for mistakes and handoff errors," he said. "It is going to be messy."

California, one of 14 states running its own exchange, has been praised for its progress compared to other states and the federal government in enrolling consumers in new insurance plans. More than 156,000 have enrolled in coverage statewide. Roughly a third of enrollees in new marketplaces nationwide are in California, and officials are expecting a rush of applications over the next several days.

California consumers have until Dec. 23 to enroll in coverage and until Jan. 6 to pay their first premium – with Christmas and New Year's holidays in the middle. Other states have even earlier deadlines for payment.

Getting coverage immediately is most important for people who have pre-existing conditions and chronic illnesses. Others may be able to wait: People can apply for coverage in 2014 until March 31.

For those anxious to get insured quickly, Peter Lee, executive director of Covered California, underscored the importance of paying the first bill on time.

"Your coverage won't be effective until your payment is received," he said at a news conference on Thursday. "There is a lot of talk about enrollment. When we come into January and February, we are going to talk about one thing – ­­­who has insurance."

Federal officials also are concerned about the time crunch. The administration asked insurers last week to let consumers pay later in January for coverage that would still begin Jan. 1 and to allow partial payments for the first month. Insurers have not yet responded.